|
AB CMV IGM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
401386645
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
AB CMV IGM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
401386645
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.12
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.85
|
| Rate for Payer: Clover Medicare Advantage |
$16.01
|
| Rate for Payer: EmblemHealth Commercial |
$50.55
|
| Rate for Payer: Humana Medicare Advantage |
$17.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
ABDOMEN 2 VIEWS
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
2003070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
ABDOMEN 2 VIEWS
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
94061508
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.87 |
| Max. Negotiated Rate |
$2,231.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$32.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$86.94
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,326.00
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
|
ABDOMEN 2 VIEWS
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
2003070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.87 |
| Max. Negotiated Rate |
$2,231.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$32.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$86.94
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,326.00
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
|
ABDOMEN 2 VIEWS
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
94061508
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
ABDOMEN 3 OR > VIEWS
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
94061509
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
ABDOMEN 3 OR > VIEWS
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
2003071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
ABDOMEN 3 OR > VIEWS
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
94061509
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.46 |
| Max. Negotiated Rate |
$2,231.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$86.94
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,326.00
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
|
ABDOMEN 3 OR > VIEWS
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
2003071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.46 |
| Max. Negotiated Rate |
$2,231.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$86.94
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,326.00
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
|
ABDOMEN COMPLETE
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76700
|
| Hospital Charge Code |
94061163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$1,005.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
|
|
ABDOMEN COMPLETE
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76700
|
| Hospital Charge Code |
94061163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.90 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$108.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,742.00
|
| Rate for Payer: Oxford Commercial |
$2,697.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,904.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$211.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.28
|
|
|
ABDOMEN SINGLE VIEW
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
94061125
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$2,231.00 |
| Rate for Payer: Aetna Commercial |
$281.22
|
| Rate for Payer: Aetna Medicare Advantage |
$334.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$375.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$375.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$103.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$26.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$375.05
|
| Rate for Payer: Cigna Commercial |
$207.24
|
| Rate for Payer: Cigna Medicare Advantage |
$72.37
|
| Rate for Payer: Clover Medicare Advantage |
$98.22
|
| Rate for Payer: EmblemHealth Commercial |
$310.17
|
| Rate for Payer: Humana Medicare Advantage |
$106.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$103.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,326.00
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
|
ABDOMEN SINGLE VIEW
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
94061125
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
ABDOMEN SURGERY PROCEDURE
|
Facility
|
OP
|
$859.60
|
|
|
Service Code
|
HCPCS 22999
|
| Hospital Charge Code |
16000500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$797.10
|
| Rate for Payer: Aetna Medicare Advantage |
$949.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,063.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,063.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$293.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,063.04
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: Cigna Medicare Advantage |
$293.05
|
| Rate for Payer: Clover Medicare Advantage |
$278.40
|
| Rate for Payer: EmblemHealth Commercial |
$879.15
|
| Rate for Payer: Humana Medicare Advantage |
$301.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$293.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.50
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.41
|
|
|
ABDOMEN SURGERY PROCEDURE
|
Facility
|
IP
|
$4,460.94
|
|
|
Service Code
|
HCPCS 49999
|
| Hospital Charge Code |
16000756
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$669.14 |
| Max. Negotiated Rate |
$669.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$669.14
|
|
|
ABDOMEN SURGERY PROCEDURE
|
Facility
|
IP
|
$859.60
|
|
|
Service Code
|
HCPCS 22999
|
| Hospital Charge Code |
16000500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.94 |
| Max. Negotiated Rate |
$128.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.94
|
|
|
ABDOMEN SURGERY PROCEDURE
|
Facility
|
OP
|
$4,460.94
|
|
|
Service Code
|
HCPCS 49999
|
| Hospital Charge Code |
16000756
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$126.69 |
| Max. Negotiated Rate |
$5,347.00 |
| Rate for Payer: Aetna Commercial |
$2,930.85
|
| Rate for Payer: Aetna Medicare Advantage |
$3,491.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,908.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,077.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,908.70
|
| Rate for Payer: Cigna Commercial |
$2,159.89
|
| Rate for Payer: Cigna Medicare Advantage |
$1,077.52
|
| Rate for Payer: Clover Medicare Advantage |
$1,023.64
|
| Rate for Payer: EmblemHealth Commercial |
$3,232.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,109.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,077.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,159.84
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$669.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.97
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,077.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$126.69
|
|
|
ABDOMEN WITH CONTRAST
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
2200046
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
ABDOMEN WITH CONTRAST
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
2200046
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$145.87 |
| Max. Negotiated Rate |
$3,916.00 |
| Rate for Payer: Aetna Commercial |
$566.79
|
| Rate for Payer: Aetna Medicare Advantage |
$675.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$208.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$755.90
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: Cigna Medicare Advantage |
$145.87
|
| Rate for Payer: Clover Medicare Advantage |
$197.96
|
| Rate for Payer: EmblemHealth Commercial |
$625.14
|
| Rate for Payer: Humana Medicare Advantage |
$214.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$208.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,470.00
|
| Rate for Payer: Oxford Commercial |
$3,774.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,916.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$300.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.80
|
|
|
ABDOMEN W/O CONTRAST
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
2200053
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
ABDOMEN W/O CONTRAST
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
2200053
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$3,916.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$234.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$86.94
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,470.00
|
| Rate for Payer: Oxford Commercial |
$3,774.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,916.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$300.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.80
|
|
|
ABDOMEN W/WO CONTRAST
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
2200061
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$145.87 |
| Max. Negotiated Rate |
$3,916.00 |
| Rate for Payer: Aetna Commercial |
$566.79
|
| Rate for Payer: Aetna Medicare Advantage |
$675.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$208.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$288.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$755.90
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: Cigna Medicare Advantage |
$145.87
|
| Rate for Payer: Clover Medicare Advantage |
$197.96
|
| Rate for Payer: EmblemHealth Commercial |
$625.14
|
| Rate for Payer: Humana Medicare Advantage |
$214.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$208.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,470.00
|
| Rate for Payer: Oxford Commercial |
$3,774.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,916.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$300.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.80
|
|
|
ABDOMEN W/WO CONTRAST
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
2200061
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
ABDOMINAL AORTA
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
94061165
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$1,005.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
|
